Life after colorectal cancer for young adult survivors

A growing number of adults under age 50 are facing colorectal cancer, and while cancer at any age
brings lifestyle changes, these changes can be especially challenging
for those who are just starting their careers, dating, thinking about
becoming parents, or caring for kids or aging parents.

That’s because colorectal cancer treatment — often surgery plus
chemotherapy or radiation — can impact everything from bathroom use to
fertility to mental health.

We spoke with Y. Nancy You, M.D., about what young colorectal
cancer survivors can expect and the best ways to cope. Here’s what she
had to say.

Bathroom use after colorectal cancer treatment

If the tumor is too low to allow for the digestive tract to be
reconnected after surgery, colorectal cancer patients may end up with
a new waste collection method that uses an external pouch, called an ostomy.

“I always tell people once they get over having an ostomy, they can
live their lives as they did before. You can swim. You can run a
marathon. You’ll absorb the same nutrients, and you won’t get an
infection around port,” You says.

Even patients with only a temporary bag can expect to make
adjustments to their lifestyle. “Losing part of the rectum has
significant functional implications because there’s loss of storage
capacity and sometimes control. It’s also possible to have urgency,
frequency and predictability concerns. Your care team will help you
adjust and work through those issues,” You says.

Sex after colorectal cancer treatment

About 30% of men who undergo surgery and radiation as part of their
colorectal cancer treatment will have some change in their sexual function.

“We preserve nerves in the pelvis as much as we can, but with
radiation to nerve tissue, moving things during surgery and with
scarring, the patients will notice changes,” You says. “Complaints are
typically along the lines of the erection not being as firm. Some men
can also have retrograde ejaculation, which means the semen gets
ejaculated back into the bladder. It can be uncomfortable.”

While more research about female sexual function is needed, You says
women’s sexual complaints after colorectal cancer treatment can
include vaginal dryness and discomfort. Patients shouldn’t be shy
about discussing their concerns with their doctor. 

“For patients who continue to experience sexual difficulty, we
recommend them to colleagues in Psychiatry and in Urology, so that the
psychological and the organic aspects of sexual function can be
addressed,” she says.

Fertility after colorectal cancer treatment

Chemotherapy and radiation can decrease fertility. But patients now
have options for preserving their fertility before
starting cancer treatment, and the sooner you investigate these
options, the better.

“I think it’s a conversation that should be had as soon as possible
after your diagnosis and before you start treatment,” You says. “If
you think there’s even a chance you may want to have children down the
line, talk to your doctor about your fertility.”

If you’re an MD Anderson patient, ask
your oncologist for a referral to MD
Oncofertility Consult Service. Learn more about fertility and cancer.

Physical changes after colorectal cancer surgery

Most colorectal cancer patients experience physical changes after surgery.

Scarring is common, so it’s important that patients speak with their
surgeons upfront about what to expect. Patients undergoing open
surgery, for instance, will typically have a vertical scar in the
middle of the front of the body. Laparoscopic and robotic surgery
makes small incisions that can be more easily hidden. “If you ask
beforehand, your surgeon can plan out incisions with you, and may be
able to take steps, such as using stitches instead of skin staples, to
help minimize the visibility of scars,” You says.

Patients with advanced disease that has progressed to other organs
or those with recurrent disease in the pelvis may have more than just
their rectum removed. Other pelvic organs, such as the bladder or
vagina, may also need to be removed.

“In these cases, we work with our plastic surgery team to help
reconstruct the area,” You says.

Mental health after a colorectal cancer diagnosis

“There is usually some anxiety when I meet with patients for the
first time because they have a lot of fear about what’s ahead.
Sometimes this shows as anger, frustration or sadness,” You says.
“Usually, when patients receive their treatment plan, they get so
focused on what’s happening next that the anxiety subsides. Once they
stop treatment and they enter into the survivorship phase, there’s
another adjustment period. As they rebuild their life, there can be a
window for depression.”

There are people specifically skilled to help you adjust to your new
normal. If you’re an MD Anderson patient,
speak with your care team about resources and services that are
available to you to address the physical and mental changes you’re facing.

“We’re here to help you overcome cancer and get you back to doing
the things that you love to do,” You says.

Request an
appointment at MD Anderson
or by calling 1-877-632-6789.